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Health Insurance (Amendment) Bill 2012: Report and Final Stages (Continued)

Tuesday, 4 December 2012

Dáil Éireann Debate
Vol. 785 No. 1

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(Speaker Continuing)

[Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin] It does not change the broad thrust of the legislation or the intent behind it, as the Minister has explained. I believe it is worthwhile and that it serves a particular purpose. It would have to be followed by rights-based legislation and that should follow at the earliest possible opportunity. I urge the Minister to accept the amendment and appeal to him to so do.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly Sadly, Deputy Ó Caoláin has misconstrued the situation, which is a recurring problem. This universal health insurance, as outlined and committed to in the programme for Government, is not based on private insurance. The programme for Government is very clear the VHI will be retained. It is a State-owned insurer and it is to be retained as a public option. Furthermore, the assertion that these competing insurers would dictate the basic health care standard is again wrong. The Health Insurance Authority will determine the level of basic health care. It will determine the standard policy that must be available to all citizens.

The Deputy alluded to the IMPACT study. Our system will be based on a multi-payer model and will be underpinned by the principle of social solidarity, as I have said. Indeed, the Deputy quoted me as saying treatment would be based on medical need and not the ability to pay. Under UHI everyone will be insured for a standard package of curative services. A new insurance fund will subsidise or pay insurance premia for those who qualify for a full payment or a subsidy.

The IMPACT report appears to assume the Government plans to implement the Dutch model in full. This is not the case. I have made it clear on numerous occasions that what we liked about the Dutch model was the multi-payer system, but we are not importing the Dutch model into Ireland. I doubt it would work in its fullness. We looked to Britain for hospital trusts, which we find to be a suitable model from the point of view of new hospital groups, and which we will bring in next year. A report on that is to hand and is being analysed by my Department as we speak. We looked to the North of Ireland, where the special delivery unit had such success before there was a change of Minister and a change of focus. We have brought that to bear here with considerable success, if I can remind the Chamber of the 25% reduction in the number of people who must endure long trolley waits, the number of people who await inpatient treatment for a year, nine months or, indeed, three months, and that the number of children awaiting inpatient treatment has fallen by 800. The 91% reduction in those waiting nine months or longer is, to my mind, considerable progress against a backdrop of reduced budgets and staff numbers. We are also looking to Denmark and Canada for patient safety.

We are not looking at any one model. We are looking at all models and we taking from each one of them what we feel is the best solution for our country in the 21st century. We are completely reforming the health service and that cannot be done overnight. It is akin to turning a huge tanker at sea. We must maintain it while we are reforming it and we have had many people bemoaning the fact that is dangerous because it involves so much change. There is no other way to do this, however, because piecemeal change in the past has not delivered and we intend to deliver. As I have said before, quoting John Donne, no man is an island, entire of itself, and no part of the health service is an island unto itself either. The emergency department problems cannot be fixed without fixing the hospital's problems, without fixing long-term care problems in the community, and without addressing primary care issues in the community. All these things are being tackled, along with the insurance industry, which has been reformed. I do not believe at any time in the history of this State there has been so much reform undertaken in the health service.

The IMPACT report argues for more analysis of a single payer model and cites Germany and France as examples of single payer models. These models both involve multiple insurance funds. The report fails to consider what would happen to the existing health insurers in Ireland, Aviva, Laya, Glo Health and the VHI, and the jobs they provide, if we introduce a single payer model. To be frank, having watched over recent years what the HSE, with a monolithic monopoly, has done to our health service, how it has robbed the front line of its ability to decide for itself what is best for the patient, I do not want to see a single payer model in this State. Competition is good. It is better for the end user, in this case the patient. If others wish to call him a client, so be it.

In essence, from a technical point of view, the principle objective of this Bill relates only to those who have chosen to avail of private health insurance cover. The issue of the basis on which access to services is available, that is, ability to pay or health needs, does not arise as that is covered by the State's current arrangements on accessibility to secondary care being free to all who reside within the State. Therefore, I do not accept the amendment.

Deputy Caoimhghín Ó Caoláin: Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin The Minister set out to attempt to rubbish the point that the so-called reform strategy and what the Minister envisages in terms of universal health insurance as the basis of the delivery of same into the future is based on competing private health insurance companies, yet he concludes by lauding and applauding that very approach. His conclusion is so contradictory from what he said at the outset that it does not stand up. The Minister cannot have it both ways.

I indicated on Committee Stage that we are both committed to universal access on the basis of need. This, however, is not the basis on which to guarantee that. There are no guarantees. The model on which the Minister is basing so much of his intent, and which I must say from the very outset was referred to consistently by the Minister and others, is the model operated in the Netherlands, and that has been shown on more careful scrutiny to be anything but what it purports to be or, perhaps, what it set out to be.

There is serious concern and a lack of confidence about the approach. The Minister has still failed to produce a White Paper. We have no outline of a plan, although we have the Minister's continued and repeated statements that he is examining this and examining that. He is looking everywhere but he is not coming forward with the outline of how this will unfold, and that is the detail people want.

When I made the point about private insurance companies being given too great a role - not the determination of it in total, but too great a role - and I believe that is what they will have, in determining the level of basic health care services available to citizens, the Minister responded that the Health Insurance Authority would determine that.

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